HIV-positive and -negative women s experiences with infertility and their care seeking behavior in Johannesburg, South Africa

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1 HIV-positive and -negative women s experiences with infertility and their care seeking behavior in Johannesburg, South Africa Lince-Deroche N, Sineke T, Hendrickson C, Kgowedi S, Mulongo M 8 th SA AIDS Conference June 2017 Durban, South Africa

2 Background It has been noted that HIV-positive individuals continue to plan for future childbearing after diagnosis (Cooper 2007, Myer 2007, Kaida 2011). Yet research has shown that being HIV-positive can reduce fertility. In multi-parous women, pregnancy risk was reduced by between 16% and 26% across three African cities (Glynn 2000). Antiretroviral medication can impact positively on fertility in HIVpositive individuals, but sero-discordance in couples can cause challenges. Despite high antiretroviral availability and known challenges with serodiscordant relationships, safe conception and fertility-related services are rare in South Africa s public health sector.

3 Study Aims / Location 1 2 To assess needs for and uptake of SRHservices among women attending clinics in Johannesburg. 3 To explore the barriers to accessing SRH services if any. To estimate women s costs of accessing SRH services. SRH = Fertility, contraception, cervical cancer, breast cancer, abortion, STIs, GBV

4 Methods Semi-structured interviews with women at clinics Eligibility: aged Systematic random sample Face-to-face interview Analysis: Descriptive statistics (Stata 14) Thematic analysis Locations and timing: HIV treatment site: Jun-Nov PHCs: April-August 2016 Presenting fertility outcomes today

5 Question on infertility during study 1. Have you tried to become pregnant during the last year? If yes: 2. Did you experience any problems while trying to fall pregnant? If yes: 3. Did you try to get help for your problem? (And if yes, where and at what cost?) If no: 4. If no, why not?

6 Most participants were married. Two-thirds were HIV+. (N=385) Age Median [IQR] 36.6 [ ] Married, unmarried/cohabitating 169 (43.9) Marital Status Partner, but not living together 140 (36.4) Single 19 (4.9) Divorced/separated/widowed 57 (14.8) Black African 337 (87.5) Race White 2 (0.5) Coloured 46 (12.0) Asian 0 (0.0) Nationality South African 305 (79.2) Non-South African 80 (20.8) Grade 7 or less 29 (7.5) Grade (46.5) Educational attainment Grade 12/matriculated 123 (32.0) Diploma/certificate/degree 54 (14.0) HIV-positive 256 (66.5)

7 Most were employed and breadwinners at home. Employment status Unemployed 131 (34.0) Self-employed(formal/informal) 23 (6.0) Employed (part/full time) 217 (56.4) Unable to work or other 14 (3.6) Primary breadwinner at home? Yes 185 (48.1) 9.4% 0.5% 60.0% 30.1% Number of chronic health conditions, including HIV (n,%)

8 Forty women (10%) of all respondents tried to get pregnant in the last 12 months. Fifteen (37.5%) reported problems. HIV-positive (n=256) YES, EXPERIENCED PROBLEMS 8, 42% 11, 58% 9, 82% Sought professional help 2, 18% Did not seek professional help HIV-negative/unknown (n=129) 0, 0% YES, EXPERIENCED PROBLEMS 17, 81% 4, 19% 4, 100% Sought professional help

9 13 women visited 16 locations for help. Just 5 (38.5%) reported getting the assistance they sought. Public hospital/clinic Private facility Traditional healer No. of visits n=10 n=5 n=1 Travel & wait time per visit (mean) 1.2 hrs 1.9 hrs 2.5 hrs Travel cost per visit (mean) R2.61 R9.44 R Missed work n=4(mean 3.3 days) Mean lost wages R Total other costs per woman (mean) R Total cost per woman (mean) R552.77

10 Reasons for not seeking professional help (n=2) I was stressed and again I thought it was natural aged 37 Because I do not know where to get help. aged 23

11 Discussion Among women who tried to fall pregnant in the last year: 57.9% of HIV-positive women reported experiencing fertility problems. 19.1% of HIV-negative women reported experiencing fertility problems. Possible over/underestimate of actual prevalence. We only spoke to women in clinics. Infertility questions were one section in larger SRH interview.

12 Discussion and conclusions The costs reported were direct costs only. We did not measure indirect costs. Recall bias? All questions were once off and required recollection of the previous year. Of the 15 women who experienced fertility problems, 86.7% (n=13) sought professional help, and just 33.3% (n=5) reported getting help.

13 Recommendations Many HIV-positive and -negative women alike may have questions about or require care for perceived infertility. When asked in this study 91.4%of women said they would like information on SRH services spontaneously offered at all clinic visits. Need to ensure service availability. 26.5% 41.0% 32.5% < No. of visits to a health facility in last 12 months (n=385) (n,%)

14 Thank you For further information